Correlation of elevated troponin and echocardiography in acute ischemic stroke
Amir Darki1, Michael J Schneck, Anoop Agrawal
1Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois.
Insights
Elevated cardiac troponin levels in acute ischemic stroke (AIS) patients correlate with cardiac issues and wall motion abnormalities. This finding aids in better risk stratification and diagnosis for stroke patients with potential cardiac comorbidities.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Elevated cardiac troponin levels are common in stroke patients, linked to adverse cardiovascular outcomes and mortality.
- Cardiac comorbidities contribute significantly to post-stroke deaths, highlighting the need to understand cardiac marker-stroke relationships.
Purpose of the Study:
- To investigate the association between cardiac troponin elevation and cardiac events in patients with acute ischemic stroke (AIS).
- To explore the relationship between cardiac biomarkers and echocardiographic findings in AIS patients.
Main Methods:
- Evaluated 137 adult patients presenting within 48 hours of AIS onset.
- Measured troponin, brain natriuretic peptide, and performed transthoracic echocardiogram with Doppler on admission.
- Analyzed the correlation between cardiac biomarkers and echocardiographic wall motion abnormalities.
Main Results:
- 17.5% of AIS patients (24/137) had elevated troponin levels.
- Among those with elevated troponin, 67% (16/24) showed new echocardiographic wall motion abnormalities suggestive of unstable atherosclerotic disease.
- A significant association was found between elevated troponin and brain natriuretic peptide levels and positive segmental wall motion abnormalities.
Conclusions:
- Elevated cardiac biomarkers in AIS patients may indicate underlying unstable atherosclerotic disease.
- These findings suggest a new approach to interpreting cardiac biomarkers for risk stratification and diagnosis in AIS patients.
Background:
Previous research has revealed a higher prevalence of elevated cardiac troponin T or I levels amongst patients admitted with stroke, which has been associated with increased cardiovascular events, higher mortality rates, and poor inpatient prognosis. Because cardiac comorbidities account for almost 20% of deaths after ischemic stroke, it is important to understand the relationship between troponin elevation, cardiac events, and acute ischemic stroke (AIS).
Methods:
We evaluated 137 consecutive patients ≥ 18 years of age who presented within 48 hours of AIS onset. All patients had laboratory markers drawn on admission, including troponin and brain natriuretic peptide, along with transthoracic echocardiogram with Doppler. The mean age of our study population was 71.7 ± 14.6 years.
Results:
Twenty-four of 137 patients (17.5%) had a positive troponin level. Sixteen of 24 (67%) patients with a positive troponin level had a new wall motion abnormality on echocardiogram that was suggestive of unstable atherosclerotic disease. On statistical analysis, we found a significant association between troponin and brain natriuretic peptide elevation with positive segmental wall motion abnormality on echocardiogram.
Conclusions:
These study findings represent a new paradigm of interpreting elevated cardiac biomarkers and may help with risk stratification and diagnosis of patients presenting with AIS.
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